Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Shortness Of Breath And Fatigue After Coronary Stenting?
Question: I had a stent placement 2 weeks ago and am on all the necessary medications. Sometimes, I feel a shortness of breath and am still very fatigued. Is this normal? I start cardiac rehabilitation next week and also have my first follow up with the cardiologist since the placement.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Thank you for asking on HCM!
I understand your concern and would first recommend monitoring your blood pressure, as a possible relative hypotension may be responsible for your extreme fatigue.
From the other side, it is necessary to review your overall cardiac performance, as an abnormally decreased left ventricular function (or even diastolic) may be responsible for your shortness of breathing and the extreme fatigue too.
Coming to this point, a careful review of your cardiac ultrasound would clarify this issue.
In addition episodes of shortness of breathing or dyspnea may be an expression of myocardial ischemia (especially in diabetic patients, where dyspnea is an equivalent of chest pain).
Are you suffering from diabetes?
Also anemia should be ruled out as it may be a possible cause of your actual clinical symptomatology. A complete blood count test would rule out this possible diagnosis.
At the end I would recommend you to consider possible signs of depression and anxiety, which are common (round 60% of patients) during the first year after suffering an acute coronary syndrome.
If you have associated symptoms like anxiety, loss of hope, sleep problems, pessimistic thoughts, loss of libido or loss of life XXXXXXX etc. they would be a substantial indication for looking after a possible depression. In such a case you should consult with a mental health specialist.
If you have persistence of these clinical signs (fatigue, etc.), or evidence of hypotension, or decreased cardiac performance (please could you upload your echo report for a review), or evidence of depression, you should consult with your attending physician to find a proper management strategy.
Hope to have been helpful!
I am at your disposal for further questions.
Best regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Thank you for asking on HCM!
I understand your concern and would first recommend monitoring your blood pressure, as a possible relative hypotension may be responsible for your extreme fatigue.
From the other side, it is necessary to review your overall cardiac performance, as an abnormally decreased left ventricular function (or even diastolic) may be responsible for your shortness of breathing and the extreme fatigue too.
Coming to this point, a careful review of your cardiac ultrasound would clarify this issue.
In addition episodes of shortness of breathing or dyspnea may be an expression of myocardial ischemia (especially in diabetic patients, where dyspnea is an equivalent of chest pain).
Are you suffering from diabetes?
Also anemia should be ruled out as it may be a possible cause of your actual clinical symptomatology. A complete blood count test would rule out this possible diagnosis.
At the end I would recommend you to consider possible signs of depression and anxiety, which are common (round 60% of patients) during the first year after suffering an acute coronary syndrome.
If you have associated symptoms like anxiety, loss of hope, sleep problems, pessimistic thoughts, loss of libido or loss of life XXXXXXX etc. they would be a substantial indication for looking after a possible depression. In such a case you should consult with a mental health specialist.
If you have persistence of these clinical signs (fatigue, etc.), or evidence of hypotension, or decreased cardiac performance (please could you upload your echo report for a review), or evidence of depression, you should consult with your attending physician to find a proper management strategy.
Hope to have been helpful!
I am at your disposal for further questions.
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes, I am diabetic. I take 500mg of metformin 2x daily. I just checked my blood pressure and it is 108/63. Lower than normal before the MI as I am now on medication for it. My MI was right coronary artery, posterior descending. whatever that means. I, of course, feel quite a bit of anxiety due to the procedure, but I am also on Lexapro 10 mg per day. I don't know that maybe a short term anxiety medication might help.
Brief Answer:
Review some important topics:
Detailed Answer:
Hi again!
Coming to this point, if your blood pressure keeps appearing on such values, then probably you should discuss with your doctor to reduce vasodilators daily doses.
Please, could you upload your cardiac ultrasound report to review your remaining cardiac function after that myocardial infarction? If your shortness of breathing is substantial then diuretics could be a rationale option.
You need to closely monitor your blood glucose levels to assure then they are optimally controlled. If heart failure or renal dysfunction is confirmed, then switching to insulin would be the best choice.
Regarding anxiety and depression, I would explain that Lexapro needs around 2 weeks to start showing a beneficial effect. Meanwhile, a fast acting drug like Alprazolam 2.5 mg/day would be helpful.
If dyspnea persists you need to consult the ER doctor, for a physical exam, resting ECG, cardiac enzymes, NT-proBNP and a chest X ray study.
Best regards,
Dr. Iliri
Review some important topics:
Detailed Answer:
Hi again!
Coming to this point, if your blood pressure keeps appearing on such values, then probably you should discuss with your doctor to reduce vasodilators daily doses.
Please, could you upload your cardiac ultrasound report to review your remaining cardiac function after that myocardial infarction? If your shortness of breathing is substantial then diuretics could be a rationale option.
You need to closely monitor your blood glucose levels to assure then they are optimally controlled. If heart failure or renal dysfunction is confirmed, then switching to insulin would be the best choice.
Regarding anxiety and depression, I would explain that Lexapro needs around 2 weeks to start showing a beneficial effect. Meanwhile, a fast acting drug like Alprazolam 2.5 mg/day would be helpful.
If dyspnea persists you need to consult the ER doctor, for a physical exam, resting ECG, cardiac enzymes, NT-proBNP and a chest X ray study.
Best regards,
Dr. Iliri
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
